Mental Health May Play Big Role in Recovery After a Heart Attack

A recent study found that young and middle-aged adults who experienced severe psychological distress, such as depression or anxiety, after suffering a heart attack were more than twice as likely to suffer a second cardiac event within 5 years compared with those experiencing only mild distress.

The study, conducted by the American College of Cardiology, is the first to comprehensively assess how mental health influences the outlook for younger heart attack survivors. The researchers focused on tracking inflammatory markers that appear to have a role in increasing cardiovascular risk among people experiencing distress. These findings align with previous studies focusing on older adults, bolstering the evidence for mental health as an integral part of a person’s recovery after a heart attack, according to the authors.

“Our findings suggest that cardiologists should consider the value of regular psychological assessments, especially among younger patients,” said Mariana Garcia, MD, a cardiology fellow at Emory University in Atlanta and the study’s lead author, in a press release. “Equally importantly, they should explore treatment modalities for ameliorating psychological distress in young patients after a heart attack, such as meditation, relaxation techniques and holistic approaches, in addition to traditional medical therapy and cardiac rehabilitation.”

The researchers analyzed health outcomes in 283 heart attack survivors between 18 and 61 years of age, with an average age of 51 years. The study participants completed a series of validated questionnaires measuring depression, anxiety, anger, perceived stress, and posttraumatic stress disorder within 6 months of their heart attack. Based on these questionnaires, the researchers established a composite score of psychological distress for each participant and grouped patients based on experiences of mild, moderate, and high distress.

Within 5 years after their heart attack, 80 of the 283 patients suffered a subsequent heart attack or stroke, were hospitalized for heart failure, or died from cardiovascular causes. These outcomes occurred in approximately 47% of patients experiencing high distress compared to 22% of those experiencing mild distress.

Previous studies suggest inflammation is a mechanism through which psychological distress may lead to heart problems. In the current study, patients who experienced high distress were also found to have higher levels of 2 inflammatory markers in their blood during rest and after mental stress. These markers are known to be associated with plaque buildup in the arteries and adverse cardiac events, in addition to increasing during times of mental stress, according to the study authors.

“It is thought that those who have had a heart attack may be particularly vulnerable to plaque rupture as a result of these inflammatory mechanisms at play,” Garcia said in a press release. “The association we found was independent of known cardiovascular risk factors and suggests mechanisms involving systemic inflammation in response to stress may be implicated in the likelihood of a subsequent cardiac event.”

Further, the researchers also found that patients with high distress were more often Black, female, and from a disadvantaged socioeconomic background and were more likely to smoke or have diabetes/high blood pressure.

“This finding highlights the importance of socioeconomic status in regard to higher distress and raises important questions about the role of race, sex and other factors,” Garcia said in a press release.

The research team plans to further investigate how socioeconomic and demographic factors may influence mental health among people who suffer a heart attack at a young age, since more recent studies suggest that younger adults, specifically women, account for an increasing proportion of the heart attacks occurring each year in the United States.

“Outreach to the community has led to increased awareness of traditional heart disease risk factors and focus on things like diet and exercise, but many people, particularly younger people, may not be aware of the importance of mental health,” Garcia said in a press release. “Our study offers a strong message to people recovering from a heart attack that ameliorating psychological distress is equally important.”

Garcia added that causation cannot be proven with an observational study and noted the possibility of recall bias among people with more severe disease because psychological distress was self-reported in this study.

REFERENCE

Mental health may play big role in recovery after a heart attack. American College of Cardiology. Published May 6, 2021. Accessed May 7, 2021. https://www.acc.org/about-acc/press-releases/2021/05/05/18/17/mental-health-may-play-big-role-in-recovery-after-a-heart-attack#:~:text=Young%20and%20middle%2Daged%20adults,study%20presented%20at%20the%20American